ICU mortality is increased with high admission serum osmolarity in all patients other than those admitted with pulmonary diseases and hypoxia

Shailesh Bihari, Shivesh Prakash, Sandra L. Peake, Michael Bailey, David Pilcher, Andrew Bersten

Research output: Contribution to journalArticleResearchpeer-review

2 Citations (Scopus)

Abstract

Background and objective: High serum osmolarity has been shown to be lung protective. There is lack of clinical studies evaluating the impact on outcomes such as mortality. We aimed to examine the effect of serum osmolarity on intensive care unit (ICU) mortality in critically ill patients. Methods: Data from January 2000 to December 2012 was accessed using the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Outcomes and Resource Evaluation (CORE) database. A total of 509 180 patients were included. Serum osmolarity was calculated from data during the first 24 h of ICU admission. Predefined subgroups (Acute Physiology and Chronic Health Evaluation (APACHE) III diagnostic codes), including patients with acute pulmonary diagnoses, were examined. The effect of serum osmolarity on ICU mortality was assessed with analysis adjusted for illness severity (serum sodium, glucose and urea component removed) and year of admission. Results are presented as OR (95% CI) referenced against a serum osmolarity of 290–295 mmol/L. Results: The ICU mortality was elevated at each extremes of serum osmolarity (U-shaped relationship). A similar relationship was found in various subgroups, with the exception of patients with pulmonary diagnoses in whom ICU mortality was not influenced by high serum osmolarity and was different from other non-pulmonary subgroups (P < 0.01). Any adverse associations with high serum osmolarity in pulmonary patients were confined to patients with a PaO2 /FiO2 ratio > 200. Conclusion: High admission serum osmolarity was not associated with increased odds for ICU death in pulmonary patients, unlike other subgroup of patients, and could be a potential area for future interventional therapy.

Original languageEnglish
Pages (from-to)1165-1170
Number of pages6
JournalRespirology
Volume22
Issue number6
DOIs
Publication statusPublished - 1 Aug 2017

Keywords

  • Acute Physiology and Chronic Health Evaluation III diagnostic codes
  • intensive care unit mortality
  • PaO/FiO ratio
  • pulmonary patients
  • serum osmolarity

Cite this

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title = "ICU mortality is increased with high admission serum osmolarity in all patients other than those admitted with pulmonary diseases and hypoxia",
abstract = "Background and objective: High serum osmolarity has been shown to be lung protective. There is lack of clinical studies evaluating the impact on outcomes such as mortality. We aimed to examine the effect of serum osmolarity on intensive care unit (ICU) mortality in critically ill patients. Methods: Data from January 2000 to December 2012 was accessed using the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Outcomes and Resource Evaluation (CORE) database. A total of 509 180 patients were included. Serum osmolarity was calculated from data during the first 24 h of ICU admission. Predefined subgroups (Acute Physiology and Chronic Health Evaluation (APACHE) III diagnostic codes), including patients with acute pulmonary diagnoses, were examined. The effect of serum osmolarity on ICU mortality was assessed with analysis adjusted for illness severity (serum sodium, glucose and urea component removed) and year of admission. Results are presented as OR (95{\%} CI) referenced against a serum osmolarity of 290–295 mmol/L. Results: The ICU mortality was elevated at each extremes of serum osmolarity (U-shaped relationship). A similar relationship was found in various subgroups, with the exception of patients with pulmonary diagnoses in whom ICU mortality was not influenced by high serum osmolarity and was different from other non-pulmonary subgroups (P < 0.01). Any adverse associations with high serum osmolarity in pulmonary patients were confined to patients with a PaO2 /FiO2 ratio > 200. Conclusion: High admission serum osmolarity was not associated with increased odds for ICU death in pulmonary patients, unlike other subgroup of patients, and could be a potential area for future interventional therapy.",
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ICU mortality is increased with high admission serum osmolarity in all patients other than those admitted with pulmonary diseases and hypoxia. / Bihari, Shailesh; Prakash, Shivesh; Peake, Sandra L.; Bailey, Michael; Pilcher, David; Bersten, Andrew.

In: Respirology, Vol. 22, No. 6, 01.08.2017, p. 1165-1170.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - ICU mortality is increased with high admission serum osmolarity in all patients other than those admitted with pulmonary diseases and hypoxia

AU - Bihari, Shailesh

AU - Prakash, Shivesh

AU - Peake, Sandra L.

AU - Bailey, Michael

AU - Pilcher, David

AU - Bersten, Andrew

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background and objective: High serum osmolarity has been shown to be lung protective. There is lack of clinical studies evaluating the impact on outcomes such as mortality. We aimed to examine the effect of serum osmolarity on intensive care unit (ICU) mortality in critically ill patients. Methods: Data from January 2000 to December 2012 was accessed using the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Outcomes and Resource Evaluation (CORE) database. A total of 509 180 patients were included. Serum osmolarity was calculated from data during the first 24 h of ICU admission. Predefined subgroups (Acute Physiology and Chronic Health Evaluation (APACHE) III diagnostic codes), including patients with acute pulmonary diagnoses, were examined. The effect of serum osmolarity on ICU mortality was assessed with analysis adjusted for illness severity (serum sodium, glucose and urea component removed) and year of admission. Results are presented as OR (95% CI) referenced against a serum osmolarity of 290–295 mmol/L. Results: The ICU mortality was elevated at each extremes of serum osmolarity (U-shaped relationship). A similar relationship was found in various subgroups, with the exception of patients with pulmonary diagnoses in whom ICU mortality was not influenced by high serum osmolarity and was different from other non-pulmonary subgroups (P < 0.01). Any adverse associations with high serum osmolarity in pulmonary patients were confined to patients with a PaO2 /FiO2 ratio > 200. Conclusion: High admission serum osmolarity was not associated with increased odds for ICU death in pulmonary patients, unlike other subgroup of patients, and could be a potential area for future interventional therapy.

AB - Background and objective: High serum osmolarity has been shown to be lung protective. There is lack of clinical studies evaluating the impact on outcomes such as mortality. We aimed to examine the effect of serum osmolarity on intensive care unit (ICU) mortality in critically ill patients. Methods: Data from January 2000 to December 2012 was accessed using the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Outcomes and Resource Evaluation (CORE) database. A total of 509 180 patients were included. Serum osmolarity was calculated from data during the first 24 h of ICU admission. Predefined subgroups (Acute Physiology and Chronic Health Evaluation (APACHE) III diagnostic codes), including patients with acute pulmonary diagnoses, were examined. The effect of serum osmolarity on ICU mortality was assessed with analysis adjusted for illness severity (serum sodium, glucose and urea component removed) and year of admission. Results are presented as OR (95% CI) referenced against a serum osmolarity of 290–295 mmol/L. Results: The ICU mortality was elevated at each extremes of serum osmolarity (U-shaped relationship). A similar relationship was found in various subgroups, with the exception of patients with pulmonary diagnoses in whom ICU mortality was not influenced by high serum osmolarity and was different from other non-pulmonary subgroups (P < 0.01). Any adverse associations with high serum osmolarity in pulmonary patients were confined to patients with a PaO2 /FiO2 ratio > 200. Conclusion: High admission serum osmolarity was not associated with increased odds for ICU death in pulmonary patients, unlike other subgroup of patients, and could be a potential area for future interventional therapy.

KW - Acute Physiology and Chronic Health Evaluation III diagnostic codes

KW - intensive care unit mortality

KW - PaO/FiO ratio

KW - pulmonary patients

KW - serum osmolarity

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U2 - 10.1111/resp.13055

DO - 10.1111/resp.13055

M3 - Article

VL - 22

SP - 1165

EP - 1170

JO - Respirology

JF - Respirology

SN - 1323-7799

IS - 6

ER -